Paramedic Prescribing

Imagine a paramedic prescriber working in a 'traditional' ambulance role (double crewed ambulance or response vehicle, in an appropriately designated Advanced or Consultant Paramedic role with all the required governance and support). Perhaps their background specialism is either critical or urgent care, but as an ambulance resource today they can be sent to anything control see fit.

Their first job is to a patient with a urinary tract infection with pain and nausea. They are allergic to trimethoprim. The patient is assessed and prescribed an antibiotic, pain relief and an anti-emetic and successfully discharged at home with at least the same quality of care as would have been afforded by a competent GP.

The next incident is to a child with prolonged seizures which has caused a hypoxic cardiac arrest. They have been resuscitated but remain very unstable. They are maybe going to benefit from sedation, ventilation and inotropic support as well as second-line anti-seizure medication. Their blood sugar is 29.2 and they are showing signs of diabetic ketoacidosis.

Is the onus on the individual paramedic prescriber/trust/wider profession to provide medication intervention to at least the same level as a competent paediatric intensivist?

Other non-medical prescribers work in more predictable surroundings such as urgent care centres, intensive care or community specialist teams. If they are in an acute hospital they are in easy reach of other prescribers who can support decision making. HEMS doctors predict they are going to be targeted at critical care and out of hours GPs urgent care. When something crosses this boundary, other prescribers might reasonably argue 'I wasn't expecting to encounter this situation so was not competent or appropriately equipped to deal with it'.

In an ambulance service where calls are not predictable and clinicians get whatever job needs to be covered, are paramedic prescribers going to be in a unique and untested position of being expected to prescribe to all and be carrying a formulary to support that? Or will it he medico-legally safe to argue they provide competent prescribing skills to some patients but not others?

Matt Green @MLG1611
February 2017